J Korean Surg Soc.  2007 May;72(5):426-429.

Liver Transplantation for a Cirrhotic Patient with Situs Inversus

Affiliations
  • 1Department of Surgery, College of Medicine, Hallym University, Seoul, Korea. jskim@hallym.or.kr
  • 2Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea.

Abstract

Situs inversus refers to a mirror image of the viscera, while situs solitus is defined as the normal anatomical situation. Several cases of successful liver transplantation for situs inversus recipients have been reported, and modifications of the standard surgical techniques were used. We report here on a case of cadaveric liver transplantation in an end-stage liver disease patient with situs inversus. The donor liver was rotated clockwise 90 degrees to the left with the right lobe lying in the left upper quadrant and the left lobe pointing down into the left iliac fossa. The donor's suprahepatic vena cava was oversewn and the infrahepatic vena cava anastomosed end to side to the recipient's inferior vena cava. The postoperative course was good until the postoperative 26th day, when rupture of a hepatic artery pseudoaneurysm occurred. An emergency laparotomy was done and the hepatic artery was ligated. Despite the hepatic artery ligation, the liver function recovered quite well. But sudden intracranial hemorrhage developed on the postoperative 28th day and sadly, the patient expired on the postoperative 30th day. Complete preoperative evaluation of the recipient is essential for the operative planning, and careful donor selection should be attempted to obtain a smaller graft to allow maximum flexibility for placing the donor liver. The use of a reduced-sized graft should be considered in the case for which a smaller graft is not available. In conclusion, adult situs inversus is no longer a contraindication for a liver transplant, although technical difficulties do exist for this procedure.

Keyword

Situs inversus; Liver transplantation

MeSH Terms

Adult
Aneurysm, False
Cadaver
Deception
Donor Selection
Emergencies
Hepatic Artery
Humans
Intracranial Hemorrhages
Laparotomy
Ligation
Liver Diseases
Liver Transplantation*
Liver*
Pliability
Rupture
Situs Inversus*
Tissue Donors
Transplants
Vena Cava, Inferior
Viscera
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